Lingual Exercise in Older Veterans With Dysphagia: A Pilot Investigation of Patient Adherence

Abstract

Purpose Adherence is a concern in dysphagia management. Poor adherence with recommendations can negatively affect treatment efficacy and patient outcomes. For exercise-based therapies, low adherence can alter the dose of exercise delivered to the muscle, which can diminish impact of exercise. It has been established that low adherence is a problem in dysphagia treatments; however, relationships among levels of adherence and outcomes from exercise-based interventions have not been explored. Method In this retrospective pilot study, data were collected from a multicenter clinical demonstration program in the Veterans Affairs hospital system to examine the relationships between patient adherence with a device-facilitated lingual exercise regimen. Outcomes were compared pre- and posttreatment using a paired t test or Wilcoxon matched-pairs signed-ranks test, and relationships among adherence and outcome measures were evaluated using Pearson or Spearman rank correlation coefficients, as appropriate. Results Patient adherence was evenly distributed across participants: Adherence at the front sensor was 59.3% ( SD = 28.2), ranging from 5.5% to 95.8%; the back sensor adherence was 55.9% ( SD = 29.8), ranging from 1.1% to 97.2%. Maximum isometric pressure (MIP) generation, at both the front and back sensors, was increased from pre- to posttreatment ( p < .0001, front; p = .008, back). Functional Oral Intake Scale (FOIS) scores were also significantly improved at the posttreatment time point as compared to baseline ( p = .005). However, there were no significant correlations among adherence and outcome measures (front sensor adherence vs. ΔMIP, r = −.161, p = .342; back sensor adherence vs. ΔMIP, r = .002, p = .991; front sensor adherence vs. ΔFOIS, r = −.183, p = .279; back sensor adherence vs. ΔFOIS, r = −.160, p = .399). Conclusions These findings suggest that patient adherence with this lingual exercise program was not related to the increases in lingual pressure generation or improvement in functional oral intake observed in this cohort. These preliminary findings suggest the need for future, prospective, controlled, and randomized clinical trials to further investigate patient adherence with a lingual exercise program and related impacts of adherence on exercise dose and swallowing-related outcomes.